Vestibular testing

Overview

Vestibular testing is a group of tests that check how well your inner ear balance system (the vestibular system) is working. These tests help doctors find out why you might feel dizzy, unsteady, or have vertigo (a spinning sensation).

Yes, vestibular testing is a common procedure for people who have dizziness or balance problems that do not go away on their own.

Vestibular testing is used for people of all ages, including children and older adults, who are having symptoms of a balance disorder.

Symptoms

Common symptoms

• Dizziness or feeling lightheaded
• Vertigo (a spinning or whirling sensation)
• Loss of balance or unsteadiness
• Nausea or vomiting with dizziness
• Sensitivity to motion (motion sickness)
• Blurred vision or trouble focusing when moving
• A feeling of floating or falling

Symptoms in children

• Frequent falls or clumsiness
• Complaints of feeling 'wobbly' or dizzy
• Head tilting or changes in walking pattern
• Avoiding playground activities or sports

Symptoms in older adults

• Increased risk of falls
• Fear of walking or going outside
• Struggling to walk in the dark or on uneven surfaces
• Dizziness when standing up quickly (orthostatic hypotension)

Causes

Main causes

• The most common reasons for having vestibular testing are disorders of the inner ear that cause dizziness or vertigo, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, or Meniere's disease.
• Other causes include head injuries, migraines, certain infections, or problems with blood flow to the inner ear.
• Sometimes the cause is not clear, and testing helps rule out serious conditions.

Risk factors

• Age – older adults have a higher chance of balance problems
• Previous head trauma or ear infections
• Family history of balance disorders
• Autoimmune conditions or diabetes
• Taking certain medications that affect balance

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe dizziness along with any stroke-like symptoms (slurred speech, facial droop, weakness on one side, trouble walking or seeing)
• If you faint or lose consciousness
• If you have a head injury and dizziness

Book a routine appointment if:

• If you have ongoing dizziness or vertigo that does not get better on its own after a few days or weeks
• If dizziness affects your daily activities or makes you afraid to move around
• If you are an older adult and have fallen because of dizziness

Diagnosis

Your doctor will first take a detailed history of your symptoms and do a physical exam. If they suspect a balance problem, they may refer you for vestibular testing. The tests are usually done by an audiologist (hearing specialist) or a neuro-otologist (ear and brain specialist).

Tests that may be done

• Videonystagmography (VNG): Uses goggles with cameras to record your eye movements as you follow lights or change head positions.
• Rotary chair test: You sit in a computer-controlled chair that moves gently from side to side while your eye movements are measured.
• Vestibular evoked myogenic potentials (VEMP): Tests how your inner ear responds to sounds or vibrations using small stickers on your neck or near your eyes.
• Computerized dynamic posturography: You stand on a platform that moves slightly to test your balance under different conditions.
• Caloric test: Warm or cool air or water is gently puffed into your ear canal to see how your inner ear responds (may cause brief dizziness).

What to expect at your appointment

Most tests take an hour or two in total. You may feel dizzy or nauseous during some parts, but the feeling is temporary. You should not eat a heavy meal just before the tests, but ask your clinic for specific instructions. Wear comfortable clothing and avoid wearing eye makeup for VNG. You can usually go home the same day and resume normal activities.

Treatment

Treatment for balance problems depends on the underlying cause found by vestibular testing. Many issues can be managed with lifestyle changes, exercises, or simple maneuvers. Your doctor will create a plan tailored to you.

Self-care at home

• Avoid sudden head movements that trigger dizziness
• Use good lighting at home to reduce fall risk
• Sit down immediately if you feel dizzy
• Stay hydrated and avoid caffeine or alcohol if they worsen your symptoms
• Slow down when changing positions – from lying to sitting, or sitting to standing

Medical treatments

Depending on the diagnosis, treatment may include a head repositioning maneuver (for BPPV), vestibular rehabilitation therapy (exercises to retrain your brain to compensate for balance issues), or medications to reduce dizziness or nausea (always prescribed by a doctor). For some inner ear conditions, a low-salt diet or diuretics may be recommended. Your doctor will discuss the options that are safest for you.

When is surgery considered?

Surgery is rarely needed for balance disorders. It may be considered only if a condition like Meniere's disease does not respond to other treatments and severely affects quality of life. Your doctor will discuss the risks and benefits.

Living with this condition

Living with dizziness can be challenging, but many people improve with treatment. Take things slowly, use handrails on stairs, and keep your home free of clutter to avoid falls. Plan rest breaks during the day. Most people can return to work and normal activities once their symptoms are controlled.

Lifestyle tips

• Avoid sudden, jerky movements
• Use a walking stick if you feel unsteady
• Learn to recognise triggers (certain positions, bright lights, loud noises) and reduce exposure
• Ask your doctor about driving restrictions if you have frequent vertigo

Diet and exercise

A balanced diet helps overall health. If you have Meniere's disease, your doctor may suggest a low-salt diet. Gentle exercise like walking, tai chi, or yoga can improve balance over time. Vestibular rehabilitation exercises (taught by a physiotherapist) are very effective.

Mental health and emotional wellbeing

Ongoing dizziness can cause anxiety, depression, or fear of going out. It is normal to feel worried. Tell your doctor if dizziness is affecting your mood. Talking to a counsellor or joining a support group can help.

Prevention

Many causes of dizziness cannot be prevented, but you can reduce the risk of falls by staying active and making your home safer. Treating underlying conditions like migraines or diabetes may also help.

Vaccines

Some inner ear infections can be prevented by vaccines, such as the flu vaccine or the pneumococcal vaccine. Ask your doctor which vaccines are right for you.

Screening programmes

There is no routine screening for balance disorders, but regular hearing checks may detect early inner ear problems. If you have symptoms, do not wait – talk to your doctor.

Complications

If left untreated

• Falls and injuries, especially in older adults
• Persistent dizziness that limits daily activities (working, driving, socialising)
• Anxiety or depression due to fear of vertigo attacks
• Possibility of falls leading to fractures or head injuries

Long-term outlook

For most people, dizziness improves with proper diagnosis and treatment. Even if the underlying condition cannot be cured, vestibular rehabilitation and lifestyle changes can help you manage symptoms and live a full, active life. Work with your healthcare team to find what helps you best.

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